Sunscreen and Sunburn for Hawaii Visitors: Graphic from Photo by Donnie MacGowan

There are many wondrous, enigmatic and fascinating attractions on the Big Island of Hawaii, some better known than others, many out of the way and generally off the beaten track. Tour Guide Hawaii has produced an encyclopedic collection of the most up-to-date information, presented as short GPS-cued videos, in an app downloadable to iPhone and iPod Touch that covers the entire Big Island, highlighting the popular and the uncrowded, the famous and the secluded, the adventurous and the relaxing.

Freed from the dark and cold of winter or rainy spring weather on the mainland, visitor’s to Hawaii often assume that, although warmer and more sunny, the tropical sun in Hawaii is fairly safe to move about in without much protection—after all, it feels so good, what could be more natural than sun light, right? Nothing could be farther from the truth and these tourists risk a nasty sunburn, ruining their vacation and creating future health problems, by not taking our sunshine seriously.

Your mainland skin, deprived of summer sun for many months, is actually very susceptible to burning, and to forming incipient skin cancers, Remember the song: “Only mad dogs and Englishmen go out in the mid-day sun!” and take steps to insure that you protect your skin, your health and your vacation.

When you first arrive in Hawaii, try limiting your exposure to 15 minutes the first day, increasing slowly each day to a maximum of one hour; Kua Bay, Kona Hawaii: Photo by Donnie MacGowan

Sun tan and sun burn are both caused by ultraviolet radiation (UV) in sunlight. Your body’s natural defense against UV radiation is to increase the amount of brown pigment (melanin) in the epidermis as exposure increases. Melanin absorbs and scatters the UV radiation, dissipating it as heat.

Ultraviolet radiation is divided up into three bands, UVA, UVB and UVC. UVC rays do not reach earth’s surface so are unimportant here. UVA radiation does not cause sunburn, but rather oxidizes existent melanin in the skin to a light brown “quick tan” that lasts only a few days. UVA exposure also triggers the release of more melanin into the skin; this can cause melanoma if exposure is intense or prolonged. It is important to note that many sunscreens do not block UVA radiation, at all.

UVB exposure acts unilaterally to increase the body’s output of melanin and yields a tan that takes upwards of 3 days to to develop, depending upon your skin. This is why some experts advise getting a “base tan” before going to Hawaii–to start the body’s natural process of producing melanin. Evidence is equivocal on whether this actually helps you acquire a better tan, but it does nothing to prevent sunburn of exposed, unprotected skin. You will burn right through your pre-tan and peel to white–ruining your vacation and your tan–if you do not protect your skin. Additionally, UVB is thought to be the more dangerous radiation, as prolonged exposure causes squamous and basal cell carcinomas. It should be noted extended use of UVB blockers can also cause Vitamin D deficiency.

Prevention of Sunburn

Hikers on the summit of Mauna Kea look over to Mauna Loa. Altitude, snow and sun, an obvious recipe for sunburn: Photo by Donald B MacGowan

The tropical sun is much more intense than temperate sunshine, even summer sun, and visitors often underestimate its devastating strength until too late–if you feel like you are starting to get pink, you have already waited too long to apply sunscreen. Additionally, the environment in Hawaii is conducive to exacerbating our already intense sunshine–reflection from water and sand (thus, the beach) greatly increase exposure to UV radiation, as does reflection from roadways, snow and increases in altitude. Since UV radiation pierces clouds, you can get a bad burn on even a cloudy day. In addition, there are many common photo-sensitizing drugs (antihistamines, antibiotics, chemotherapy, cardiac drugs, etc—even many fragrances) that can cause one to be more susceptible to damage from the sun’s rays. If you are unsure if your prescription falls in this category, talk with your eye-doctor, your pharmacist or physician before traveling.

Arriving in Hawaii with a good tan is not prevention enough-you need good strategies for dealing with the savage tropical sun. You can stay indoors and severely limit your exposure; this gives safety and certainty but doesn’t sound like very much fun (unless you are on your honeymoon). A better strategy is to cover up with clothes, a sun hat, seek shade when possible and avoid exposure during peak sun times (between 10 am and 2 pm)…probably not much fun, either.

The best strategy is to obtain and use a quality sunscreen of at least SPF 50 and undertake a period of adjustment for your tender skin with lengthening times of exposure. Start with 15 minutes direct exposure (here we’re talking about sunbathing), adding about 10 minutes a day to a maximum of one hour. Coupled with judicious use of clothing and a sun hat, shade-seeking and limiting exposure until your skin is ready, should keep you from getting crisped and ruining your vacation.

So let’s talk a little bit about sunscreens. Sunscreens act via three different mechanisms: organic compounds that absorb UV light (cf. oxybenzone); inorganic particulates that block and scatter all light including UV (cf. zinc oxide; these are the so-called “sun blocks”) and organic compounds that both absorb and block UV radiation (cf. Tinosorb M). Many commercial sunscreen preparations now contain a mixture of all three types of sunscreening agents

Sunlight reflected by roadways and off lava flows is another potentially dangerous source of ultraviolet radiation Saddle Road between Mauna Kea and Mauna Loa, Hawaii: Photo by Donnie

The ability of your sunscreen to protect you is rated by the SPF (for UVB) and PPD (for UVA). The Sun Protection Factor (SPF) is a laboratory measure of the effectiveness of your sunscreen to block UVB radiation and is a ratio of the amount of radiation required to cause sunburn on your skin WITH the sunscreen to the amount of UV radiation required to cause sunburn without the sunscreen. Thus, a rating of SPF 50 means that it takes 50 times as much exposure to cause sunburn when wearing the sunscreen, than it does without it.

Always be careful of sunlight reflected off water and sand; Wawaloli Beach, Kona Hawaii: Photo by Donnie MacGowan

Persistent Pigment Darkening (PPD), the sunscreen rating for UVA protection, is like SPF in that a PPA rating of 10 means you should be able to safely get ten times as much UVA exposure with the sunscreen than without.

The effectiveness of the sunscreen experienced by the tourist varies with such factors as skin type, amount applied and frequency of re-application (as well as how much sunscreen is absorbed by your skin), how much you sweat or rub off, and the kinds of activities one engages in (for instance, going snorkeling not only tends to wash the sunscreen off, but exposes you to increased radiation from water reflection).

Sunscreen application

Ultraviolet radiation pierces cloud cover, so even on cloudy days sun burn is a risk, especially here at the summit of Kilauea Volcano at 4200 feet; Hawaii Volcanoes National Park: Photo by Donald B. MacGowan

You should use 1-2 ounces of sunscreen (30-60 ml) ounces for your full body; most people get cheap, or are in a hurry, and do not use enough sunscreen. This is a mistake you are likely to make only once in Hawaii—the penalty is rather steep. You should apply the sunscreen 1/2 hour before initial exposure and then every 30 minutes thereafter. Your tube of sunscreen may claim to last all day, but it doesn’t. No, it REALLY doesn’t. No, no, no, I don’t care what the label claims, re-apply every 30 minutes. Likewise, your sunscreen may claim to be waterproof, but at best it’s merely water resistant. Seriously.

You spent a lot of money and effort to get to Hawaii and sunburn is the number one way visitor’s have their vacations ruined—and it’s the the most easily prevented. Don’t scrimp on the sunscreen, don’t get lazy, do not figure you are “immune” or “tough”. You aren’t; the sun is bigger and meaner than anybody’s skin.

Laurie Maus laughs in the tropical sun as she snorkels at Kahalu'u Beach, Kona Hawaii: Photo by Donnie MacGowan

Eyes can sunburn, too, be sure to wear adequate eye protection in the sun (a complete discussion of sunglasses and eye protection for Hawaii visitors can be found here).

Remember when using a new sunscreen, test it for allergies and and skin reactions—especially waterproof sunscreen—on a small patch of skin. I once was guiding a climb in the Tetons when a client applied a new brand of sunscreen only to discover she was allergic to it. It was a waterproof variety and we were high on a rock face without much water available and this poor woman was rapidly breaking out in an itchy rash. I have this uncomfortable image of her wildly scrubbing and scratching the stuff off with sand and snow, dangling about 1000 feet off the valley floor. Don’t repeat that mistake.

Hapuna Beach, Kohala Hawaii: Photo by Donald B MacGowan

Also, few people realize that your sunscreen kills coral and harms fish. Please do not apply it before going snorkeling, diving or swimming; use a t-shirt and ball cap to prevent sunburn, then apply your sunscreen immediately after getting out of the ocean and rinsing off with fresh water (a thorough discussion of this, and other snorkeling ethics topics, can be found here).

Treatment of Sunburn

Sunburn is quite common, with more than 30 percent of adults and 70 percent of children and adolescents reporting sunburn to their physician at least once during the course of a year; these figures are, of course, much higher for visitors to Hawaii.

Sun light reflected off the water is a prime cause of sunburn. Also be careful during water activities that your sunscreen doesn't wash off; Kailua Bay, Kona Hawaii: Photo by Donnie Mac

Unfortunately, sunburn is not immediately apparent. Redness develops between three and five hours after being out in the sun and peaks with 12-24 hours, fading within about 72 hours. Initially, skin will appear pink and may feel “itchy”. As severity increases, redness deepens and skin is noticeably hot to the touch. With severe sunburns, swelling, blisters and loss of tissue occurs. Severe sunburn is a true medical emergency and can be life-threatening; seek medical attention immediately.

Even a cloudy day at Hapuna Beach can lead to severe sun burn for the unwary, Kohala Hawaii: Photo by Donnie MacGowan

There are numerous treatments for sunburn. First, get out of the sun, immediately, and stay out until the burn fades. The pain can be relieved with aspirin or Tylenol, although their effectiveness wanes after about 24 hours. Of the many commercially available sunburn remedies, none are clinically proven to do anything but provide a temporarily soothing palliative—although none have been demonstrated to do any harm. Here in Hawaii, we are particularly fond of using sap from the aloe plant (aloe, a Hawaiian word, is more properly pronounced “ah LOY” in Hawaii) which grows wild almost everywhere in the islands. Another local remedy that I find personally soothing is to brew a large kettle of green tea, cool it to a chill in the refrigerator and then sponge it over the affected parts of my body in the shower. Smells good, too.

Remember, you worked long and hard to get your trip to Hawaii, it took a lot of effort to fly over here. Now that you are here, you want to see it all. Just one hour unguarded in the fierce Hawaiian sun can cause you to spend that vacation in misery, indoors, in no mood for a holiday. Be smart, be prepared, don’t get cocky, lazy or cheap. Buy quality sunscreen, use it liberally and use it often.

Ho'okena Beach on a semi-cloudy day is still a hazard for sunburn, Kona Hawaii: Photo by Donnie MacGowan

Sun damage to skin is cumulative over your lifetime, so take good care of it: Poipu Beach, Kauai Hawaii: Photo by Donald B MacGowan

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